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Arthur Schatzkin,

The authors' responsibilities were as follows—N.T.: developed the idea and the analytical strategy, analyzed and interpreted the data and drafted the manuscript. L.J. and N.P.: interpreted the data, contributed to the data analysis and to drafting of the manuscript. A.J.C.: interpreted the data and contributed to data analysis. N.T., J.L. and A.F.S.: created the dietary variables; V.K.: provided statistical support; V.K., A.F.S., A.H. and A.S.: helped with the conception and design of the NIH-AARP Diet and Health Study, acquired the data and interpreted the data. N.T., L.J., A.J.C., V.K., A.F.S., A.H., A.S. and N.P.: critically reviewed and revised the manuscript and approved the final version of the manuscript.

Nancy Potischman

Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD

Published 2011. This article is a US Government work and, as such, is in the public domain of the United States of America.

Tel.: 301-496-8550, Fax: 301-435-3710

Abstract

Prospective epidemiologic data on the effects of different types of dietary sugars on cancer incidence have been limited. In this report, we investigated the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 malignancies. Participants (n = 435,674) aged 50–71 years from the NIH-AARP Diet and Health Study were followed for 7.2 years. The intake of individual sugars was assessed using a 124-item food frequency questionnaire (FFQ). Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) in multivariable models adjusted for confounding factors pertinent to individual cancers. We identified 29,099 cancer cases in men and 13,355 cases in women. In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma (HRQ5 vs. Q1: 1.62, 95% CI: 1.07–2.45; ptrend = 0.01), added fructose was associated with risk of small intestine cancer (HRQ5 vs. Q1: 2.20, 95% CI: 1.16–4.16; ptrend = 0.009) and all investigated sugars were associated with increased risk of pleural cancer. In women, all investigated sugars were inversely associated with ovarian cancer. We found no association between dietary sugars and risk of colorectal or any other major cancer. Measurement error in FFQ-reported dietary sugars may have limited our ability to obtain more conclusive findings. Statistically significant associations observed for the rare cancers are of interest and warrant further investigation.

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